OCD Clinical and Research Unit. Department of Psychiatry, Hospital de Bellvitge, Barcelona, Spain; Department of Psychiatry, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain.
Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Research Unit, Arrasate-Mondragón, Spain.Biodonostia Health Research Institute, Donostia-San Sebastián, Spain; Kronikgune Institute for Health Services Research, Barakaldo, Spain.
Brain Stimul. 2022 Sep-Oct;15(5):1128-1138. doi: 10.1016/j.brs.2022.07.050. Epub 2022 Aug 1.
Twenty years after the first use of Deep Brain Stimulation (DBS) in obsessive-compulsive disorder (OCD), our knowledge of the long-term effects of this therapeutic option remains very limited.
Our study aims to assess the long-term effectiveness and tolerability of DBS in OCD patients and to look for possible predictors of long-term response to this treatment.
We studied the course of 25 patients with severe refractory OCD treated with DBS over an average follow-up period of 6.4 years (±3.2) and compared them with a control group of 25 patients with severe OCD who refused DBS and maintained their usual treatment. DBS was implanted at the ventral anterior limb of the internal capsule and nucleus accumbens (vALIC-Nacc) in the first six patients and later at the bed nucleus of stria terminalis (BNST) in the rest of patients. Main outcome was change in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score between the two groups assessed using mixed models. Secondary effectiveness outcomes included Hamilton Depression Rating Scale (HDRS) and Global Assessment of Functioning (GAF) scores.
Obsessive symptoms fell by 42.5% (Y-BOCS score) in patients treated with DBS and by 4.8% in the control group. Fifty-six per cent of DBS-treated patients could be considered responders at the end of follow-up and 28% partial responders. Two patients among those who rejected DBS were partial responders (8%), but none of the non-DBS group achieved criteria for complete response. HDRS and GAF scores improved significantly in 39.2% and 43.6% among DBS-treated patients, while did not significantly change in those who rejected DBS (improvement limited to 6.2% in HDRS and 4.2% in GAF scores). No statistically significant predictors of response were found. Mixed models presented very large comparative effect sizes for DBS (4.29 for Y-BOCS, 1.15 for HDRS and 2.54 for GAF). Few patients experienced adverse effects and most of these effects were mild and transitory.
The long-term comparative effectiveness and safety of DBS confirm it as a valid option for the treatment of severe refractory OCD.
在深部脑刺激（DBS）首次用于强迫症（OCD）治疗二十年后，我们对这种治疗选择的长期效果的了解仍然非常有限。
本研究旨在评估 OCD 患者接受 DBS 治疗的长期疗效和耐受性，并寻找长期治疗反应的可能预测因素。
我们研究了 25 例接受 DBS 治疗的严重难治性 OCD 患者的病程，平均随访时间为 6.4 年（±3.2），并将其与 25 例拒绝 DBS 并维持常规治疗的严重 OCD 患者进行比较。DBS 在前内囊腹侧肢和伏隔核（vALIC-Nacc）植入前 6 例，其余患者在终纹床核（BNST）植入。主要结局是采用混合模型比较两组患者耶鲁-布朗强迫症量表（Y-BOCS）评分的变化。次要疗效结局包括汉密尔顿抑郁量表（HDRS）和总体功能评估量表（GAF）评分。
DBS 治疗组患者的强迫症状下降了 42.5%（Y-BOCS 评分），而对照组仅下降了 4.8%。DBS 治疗组 56%的患者在随访结束时可被认为是应答者，28%为部分应答者。拒绝 DBS 的 2 例患者为部分应答者（8%），而非 DBS 组无完全应答者。DBS 治疗组中有 39.2%和 43.6%的患者 HDRS 和 GAF 评分显著改善，而拒绝 DBS 的患者则无明显改善（HDRS 评分改善仅为 6.2%，GAF 评分改善 4.2%）。未发现应答的统计学显著预测因素。混合模型显示 DBS 的比较效果非常大（Y-BOCS 为 4.29，HDRS 为 1.15，GAF 为 2.54）。少数患者出现不良反应，大多数不良反应轻微且短暂。
DBS 的长期比较疗效和安全性证实其为治疗严重难治性 OCD 的有效选择。
